| NPI | 1922620699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2024-08-05 |